C-Spine lecture3 Flashcards
abnormal acceleration deceleration of head, neck and torso
whiplash
0-50 ms during whiplash
car seatback pushes torso forward, straightening of T and C spine while head remains stationary
principle cervical trauma site at 0-50ms
craniovertebral junction
75 ms during whiplash
phase with maximal elongation of vertebral artery. s-shaved curve with flexion at the upper levels and hyper extension at the lower levels
at 75 ms, physiologic extension limits were exceeded at
the intervertebral levels of C6-T1
brain injury with whiplash
when head is thrown back, brain collides with front of skull. opposite happens when head is thrown forward
one thing to note about symptoms of WAD
they are highly variable and non specific
____ percent of patients will become chronic
20-25%
Prognostic indicators for chronic WAD (high evidence)
Elevated initial self reported pain (7/10), Extreme disability (NDI>40/100)
increased sensitivity to ____ is associated with ongoing disability after whiplash
cold
low self-efficacy, catastrophizing, lower edu level, reduced ROM, anxiety are all…
associated with ongoing pain after whiplash
T/F direction of impact is associated with ongoing pain in WAD
F
Grade 0 QTF
No complaint about the neck. no physical signs
Grade 1 QTF
Neck complaint of pain, stiffness, or tenderness only. no physical signs
Grade 2 QTF
neck complaint AND MSK signs. MSK signs include decreased ROM and point tenderness.
Grade 3 QTF
Neck complaint AND neuro signs. Neuro signs include decreased or absent DTR, weakness and sensory deficits
Grade 4 QTF
Neck complaint AND fracture or dislocation
How long should pts wear a soft collar
for WAD 2 & 3, first 72 hrs (crawford found no benefit in functional recovery
Controlled rest
QTF: 1-4 days, WAD II & III
Is mm stretching appropriate in the acute phase?
no. because it causes pain
When can you progress to mm stretching as tolerated
sub acute phase
one sided headache, 4-72 hrs, thobbing
migraine
widespread headache, until treated, dull
sinus
widespread headache that last for hours, dull
tension
one sided, sharp headache that lasts 15 min to 3 hrs
cluster
headaches arising from MSK disorders of the c-spine (headband like)
cervicogenic headache
3 headache treatment categories
- c spine manip or mob
- DNF strengthening
- UQ strengthening
Vertebral artery or vertebrobasilar injury. 5D and 3 ns
Dizziness, drop attacks, diplopia, dysarthria, dyspahgia, ataxia, anxiety, nausea, numbness, nystagmus
Acute onset headache “unlike any other” is
a red flag for vertebrobasilar artery disease
published contraindications to thrust manips
multi level nerve root pathology, worsening neuro function, unremitting, severere, non-mechanical pain, unremitting night pain (preventing pt from falling asleep), relevant recent trauma, UMN lesions, spinal cord damage
The principle of all techniques is that ____ force should be applied to any structure withing the c spine
minimal (low amplitude, short lever thrusts
___ ____and ____ form the basis of appropriate tehcnique selection
patient safety, comfort
Cervical manips should not be perfomed at the end range, particularly
extension and rotation
_______ prior to a manip is good practice to eval pt comfort and to enable eval of their response
positioning the patient in the pre-manip test position
Avoid c-spine manip during the ___ ____ of managing a pt with a recent onset of head and neck pain
first week, treat with t spine manp and c-spine ROM
T/F if the “unthinkable” happens during a manip, simply manip the other way
F dumbass
CPR for neck manip
- 38 days or less duration of symptoms
- positive expectation that manip will help
- difference in c spin rotation ROM to either side at least 10 degrees
- pain with (PA) testing middle c-spine
if pt has 3/4 conditions, increases post-test prob of success to 90%
history: insidious or acute, inciting events include trauma, emotion, stress, fatigue, posture, hormonal changes, pain pattern is dull and aching, may have pain referred into head, arms, midscap
myofascial pain syndrome
Myofacial pain syndrome exam findings
presence of trigger points, mobility loss and mm strength/length (variable), upper crossed syndrome, no neuro findings (if MPS only)
what is a trigger point
taut, palpable band, tenderness along band, twitch response with transverse palpation, pain referral with TP palpation
C1 fx from axial load
jefferson fx
C2 pedicle fx from sudden hyperextension
hangman’s fracture
C2 dens fx from combined hyperextension/rotation
odontoid fx
lower c-spine spinous process fx from forced hyperflexion
Clay shoveler’s fx
general guidlines post-surgical rehab for fracture/dislocaiton
cervical collar 4-6 weeks, walking program, ROM exercise:pt tolerance at 6 weeks, mm strengthening at 8-10 weeks (start with isometrics, progress to isotonics with manual resistance)
